Papua New Guinea

Monday, January 15, 2007

Getting up at 3:30am is never a pleasant experience… Those that know me know that 3:30am for me is more likely to be a late night than an early morning. Fortunately our early start was for a flight to Irian Jaya - a trip I had been looking forward to for some time.

One of the two objectives for our mission to Indonesia has been to develop a proposal for Canadian Red Cross and the Canadian International Development Agency for a bed-net campaign in eastern Indonesia where malaria morbidity and mortality rates are extremely high and where there is currently no prevention strategy in place. We’ve come to Irian Jaya to assess the malaria situation and get a better understanding of field conditions in this remote part of Indonesia.

Irian Jaya is a recently created province on the island of Papua New Guinea, at the far eastern edge of the vast Indonesian archipelago. This island is one of the most remote regions on earth where isolated and marginalized communities suffer the highest rates of malaria morbidity and mortality, maternal mortality, and malnutrition in Indonesia.

We were joined on our early morning flight by our UNICEF – Malaria Program counterpart, Dr. Endang, who acted both as our guide and our translator. Joining us once we arrived was the local Ministry of Health - National Malaria Control Program representative. Together we made our way out of the main town site to the more remote rural villages to conduct house to house visits in order to speak with community members.As we drove, glimpses of crashing waves caught between the passing palms made it impossible not to be awestruck by the island’s sheer beauty. Home to one of the oldest and most biologically diverse rainforests on earth, an alluring sense of mystery seemed to emanate from the dense jungle hillsides that rose abruptly from the island’s coast.
We arrived in a small rural village made up of a scattering of 40 or so homes; basic wood structures raised on stilts that peeked out from the dense forest.

Our arrival drew attention from many of the village’s children who came to check us out while their mothers peered shyly from windows and door frames. We were welcomed graciously into their modest homes where we sat crowded round on the floor listening as Dr. Endang asked them about their family’s living conditions and overall health.

They explained that they and their children were often sick with fever and many families reported having lost children who had died following fevers. This confirmed the high prevalence of malaria in the region though it was clear there was little understanding of the disease. Many attributed fevers and other illness to ‘spirits’ and when asked if they sought treatment when they or their children were sick replied that they relied on traditional spiritual healers.

When asked if they would ever seek treatment at medical centres, some said they would but only if illness persisted for longer than three days; much too late given how critical the first 24 hours from the onset of malarial fever are for treatment. Others said they were not able to reach medical centres as there were none close by and the cost of travel to the nearest facility was too expensive. When treatment was sought, and when it was available, often it was not effective as most places were only able to treat with chloroquine, an older treatment method whose effectiveness has been compromised by drug resistance.

These testimonials underlined the need not only for better access to malaria treatment but also for grassroots education around malaria; its cause, its symptoms, and its treatment and prevention. The lack of knowledge of the link between malaria and mosquitoes was one factor why most people we spoke with were not familiar with bed-nets, the most effective and affordable form of prevention. As such, any bed-net distribution would surely have to involve a great deal of education and socialization on net use.

Information gathered from these types of visits seemed invaluable for formulating a regionally and culturally appropriate malaria prevention strategy. For example, sitting on the slatted wood floor of a stilt-raised home, I noticed how easily mosquitoes could pass up through the floor between the slats. Given that most villagers slept on very small mats or directly on the floor, consideration would have to be given to the design of the bed-net to ensure their effectiveness.

The responsibility to ensure aid and health programs are regionally and culturally appropriate cannot be overstated. While societies such as the ones here in Irian Jaya are able to adapt (and do), cultural changes should occur on their terms. Mostly isolated until the turn of the last century, the remote villages of Irian Jaya now reflect some of the cultural shifts seen round the world.

The juxtaposition between the spears and bows leaning in the corner of one home we visited and the television set beside them provided evidence that even the traditional hunting and subsistence societies found here are part of our increasingly interconnected world. The tattered poster of Avril Lavigne that hung as the sole decoration in another home served as an equally good, if not somewhat more perplexing, example.

While it is probably fair to question the value of either a television set or a poster of a Canadian pop star, for me they are positive signs for what is possible; the exchange of tools and ideas. There are valid concerns with the pace and manner in which cultures shift, but when it comes to preventing children from dying there is little room for argument when proven and effective prevention and treatment strategies exist.

In one house we visited a young child pulled herself awkwardly across the floor, her emaciated legs unable to carry the weight of her ballooned, worm filled stomach. A de-worming tablet costing less than three cents could very well save her life, but without it she would likely die within a week.

Images such as this stand out as a reflection of the reality here, but so to do images of local community members who have the willingness and capacity to help. There is a danger in allowing the former to overshadow the latter, as for every example of tragedy there are equally as many of hope.
posted by Adam Johnston at 10:30 PM

1 Comments:
Anonymous said...
Hi Adam,I keep reading your blogs as you add new information and each time I am struck by the realism you bring home to us. I think we are all aware of the problems you are describing, but we are so removed from them that it is easy to forget how fortunate we really are.Please stay safe and healthy.Love Gaile, Al & Family
February 28, 2007 11:36:00 PM PST